To investigate the clinical features and treatment outcomes of vitreoretinal lymphoma (VRL)

Methods

This study included consecutive patients with VRL pathologically confirmed during last 15 years at two nationally largest tertiary hospitals in Korea. Medical records of the subjects were retrospectively reviewed for demographic data, ocular manifestation, and treatment outcomes regarding vision and survival.

Results

Ninety-nine eyes from 66 patients with primary or secondary VRL were included. The mean subject age was 59.5 ± 11.1 years and 39 (59%) patients were male. Ocular involvement was bilateral in 42 (66%) patients and the mean follow-up period was 24.2 ± 22.4 months. The most common histologic type of VRL was diffuse large B-cell lymphoma (94%). Diagnostic modalities included vitreous cytology (27%), brain biopsy (52%) and biopsy of other organs (21%). Diagnostic yield of vitreous cytology was 55%.<br /> VRL was a primary form in 22 (33%) patients, associated with primary brain lymphoma in 28 (43%) patients, or associated with other systemic lymphoma in 15 (23%) patients. Mean age, male proportion, and follow-up period were not different among these clinical forms (P = 0.992, P = 0.385, P = 0.428, and P = 0.882, respectively). The most common ocular finding was vitreous haze (78%). The anterior chamber cellularity was considerably low (0.6 ± 0.5), whereas vitreous cellularity was quite high (1.6 ± 1.1). Retinal or subretinal infiltration was observed in 31% of the eyes. Main visual symptom was decreased visual acuity (63%) and floaters (11%), but 12 (18 %) subjects were asymptomatic.<br /> Chemotherapy combined with brain radiotherapy was performed in 33 (52%) patients and chemotherapy alone was done in 29 (45%) patients based on high-dose methotrexate. The median overall survival was 41.2 ± 9.5 months in the entire cohort and was not different among each clinical form of VRL (P = 0.955). Initial visual acuity at diagnosis was 0.680 ± 0.755 in logMAR and the final visual acuity was dropped to 0.943 ± 1.001 despite systemic and local treatment (P = 0.028). The causes of poor final vision included optic atrophy, chorioretinal atrophy, and phthisis.

Conclusions

Survival outcome of VRL was still poor and visual acuity was also decreased despite dedicated treatments. Ocular manifestation and overall survival was not different depending on the clinical form of VRL.